EP1888014B1 - Dental mineralization - Google Patents

Dental mineralization Download PDF

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Publication number
EP1888014B1
EP1888014B1 EP06741201A EP06741201A EP1888014B1 EP 1888014 B1 EP1888014 B1 EP 1888014B1 EP 06741201 A EP06741201 A EP 06741201A EP 06741201 A EP06741201 A EP 06741201A EP 1888014 B1 EP1888014 B1 EP 1888014B1
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Prior art keywords
acfp
dental
acp
enamel
composition
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German (de)
English (en)
French (fr)
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EP1888014A1 (en
EP1888014A4 (en
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Eric Charles Reynolds
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University of Melbourne
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University of Melbourne
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/19—Cosmetics or similar toiletry preparations characterised by the composition containing inorganic ingredients
    • A61K8/24—Phosphorous; Compounds thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/19—Cosmetics or similar toiletry preparations characterised by the composition containing inorganic ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A61K33/42—Phosphorus; Compounds thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/19—Cosmetics or similar toiletry preparations characterised by the composition containing inorganic ingredients
    • A61K8/20—Halogens; Compounds thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/19—Cosmetics or similar toiletry preparations characterised by the composition containing inorganic ingredients
    • A61K8/20—Halogens; Compounds thereof
    • A61K8/21—Fluorides; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/19—Cosmetics or similar toiletry preparations characterised by the composition containing inorganic ingredients
    • A61K8/22—Peroxides; Oxygen; Ozone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/30—Cosmetics or similar toiletry preparations characterised by the composition containing organic compounds
    • A61K8/40—Cosmetics or similar toiletry preparations characterised by the composition containing organic compounds containing nitrogen
    • A61K8/42—Amides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/30—Cosmetics or similar toiletry preparations characterised by the composition containing organic compounds
    • A61K8/64—Proteins; Peptides; Derivatives or degradation products thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/30—Cosmetics or similar toiletry preparations characterised by the composition containing organic compounds
    • A61K8/64—Proteins; Peptides; Derivatives or degradation products thereof
    • A61K8/66—Enzymes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/02—Stomatological preparations, e.g. drugs for caries, aphtae, periodontitis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61Q—SPECIFIC USE OF COSMETICS OR SIMILAR TOILETRY PREPARATIONS
    • A61Q11/00—Preparations for care of the teeth, of the oral cavity or of dentures; Dentifrices, e.g. toothpastes; Mouth rinses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2800/00—Properties of cosmetic compositions or active ingredients thereof or formulation aids used therein and process related aspects
    • A61K2800/70—Biological properties of the composition as a whole

Definitions

  • the present invention relates to mineralizing a dental surface, in particular tooth enamel.
  • a further aspect in relates to mineralizing hypomineralized lesions (including subsurface lesions) in the tooth enamel caused by dental caries, dental erosion and fluorosis.
  • Dental caries is initiated by the demineralization of hard tissue of the teeth usually by organic acids produced from fermentation of dietary sugar by dental plaque odontopathogenic bacteria. Dental caries is still a major public health problem. Further, restored tooth surfaces can be susceptible to further dental caries around the margins of the restoration. Even though the prevalence of dental caries has decreased through the use of fluoride in most developed countries, the disease remains a major public health problem. Dental erosion or corrosion is the loss of tooth mineral by dietary or regurgitated acids. Dental hypersensitivity is due to exposed dentinal tubules through loss of the protective mineralized layer, cementum. Dental calculus is the unwanted accretion of calcium phosphate minerals on the tooth surface. All these conditions, dental caries, dental erosion, dental hypersensitivity and dental calculus are therefore imbalances in the level of calcium phosphates.
  • Enamel fluorosis has been recognized for nearly a century, however, the aetiological role of fluoride was not identified until 1942 (Black and McKay, 1916).
  • the characteristic appearance of fluorosis may be differentiated from other enamel disturbances (Fejerskov et al., 1991).
  • the clinical features of fluorotic lesions of enamel (FLE) represent a continuum ranging from fine opaque lines following the perikymata, to chalky, white enamel (Fejerskov et al. , 1990; Giambro et al ., 1995).
  • fluorosis has been managed clinically by restorative replacement or micro-abrasion of the outer enamel (Den Besten and Thariani, 1992; Fejerskov et al ., 1996). These treatments are unsatisfactory because they involve restorations or removal of tooth tissue. What is desired is a treatment that will mineralize the hypomineralized enamel to produce a natural appearance and structure.
  • CPP-ACP casein phosphopeptides and amorphous calcium phosphate
  • WO 98/40406 in the name of The University of Melbourne describes casein phosphopeptide-amorphous calcium phosphate complexes (CPP-ACP) and CPP-stabilised amorphous calcium fluoride phosphate complexes (CPP-ACFP) which have been produced at alkaline pH. Such complexes have been shown to prevent enamel demineralization and promote remineralization of enamel subsurface lesions in animal and human in situ caries models (Reynolds, 1998).
  • CPP active in forming the complexes
  • active examples include peptides Bos ⁇ s1 -casein X-5P (f59-79) [1], Bos ⁇ -casein X-4P (f1-25) [2], Bos ⁇ s2 -casein X-4P (f46-70) [3] and Bos ⁇ s2 -casein X-4P (f1-21) [4] as follows:
  • the access of mineralizing ions to the tooth enamel in many cases can be limited by the layer of salivary proteins that forms over the surface of the enamel, termed the pellicle.
  • the proteins of the pellicle can also accumulate in sub-surface enamel lesions, thereby inhibiting the mineralization of these lesions. Such accumulations of proteins can discolour over time, leaving unsightly patches on the tooth. Accordingly, there is a need to remove these proteins to remove discolouration and avoid limitations of access to the enamel by remineralizing ions. To overcome these and other limitations of known treatments, research to this end has been conducted.
  • the present invention relates to mineralizing a dental surface or sub-surface including by contacting the dental surface with a protein disrupting agent, and contacting the dental surface with stabilized amorphous calcium phosphate (ACP) or amorphous calcium fluoride phosphate (ACFP).
  • the dental surface is preferably dental enamel.
  • the dental surface is a lesion in the enamel, such as a lesion caused by caries, dental erosion or fluorosis.
  • Mineralization of dental surfaces can be significantly enhanced by the disruption of pellicle proteins from the dental surface prior to the application of a remineralizing material, such as stabilised ACP and/or ACFP.
  • a remineralizing material such as stabilised ACP and/or ACFP.
  • the mineralization of enamel by stabilized soluble forms of ACP (CPP-ACP) and ACFP (CPP-ACFP) is enhanced by pre-treatment of the enamel surface with a protein disrupting agent such as alkaline bleach.
  • the ACP and/or ACFP is phosphopeptide (PP)-stabilized.
  • the phosphopeptide (as defined below) is a casein phosphopeptide.
  • the ACP and/or ACFP is in the form of a casein phosphopeptide stabilized ACP and/or ACFP complex.
  • the phase of the ACP is predominantly a basic phase, wherein the ACP comprises predominantly the species Ca 2+ , PO 4 3- and OH - .
  • the basic phase of ACP may have the general formula [Ca 3 (PO 4 ) 2 ] x [Ca 2 (PO 4 )(OH)] where x ⁇ 1.
  • the two components of the formula are present in equal proportions.
  • the basic phase of ACP has the formula Ca 3 (PO 4 ) 2 Ca 2 (PO 4 )(OH).
  • the phase of the ACFP is predominantly a basic phase, wherein the ACFP comprises predominantly the species Ca 2+ , PO 4 3- and F - .
  • the two components of the formula are present in equal proportions.
  • the basic phase of ACFP has the formula Ca 3 (PO 4 ) 2 Ca 2 (PO 4 )F.
  • the ACP complex consists essentially of phosphopeptides, calcium, phosphate and hydroxide ions and water.
  • the ACFP complex consists essentially of phosphopeptides, calcium, phosphate, fluoride and hydroxide ions and water.
  • Any suitable protein disrupting agent can be used in the method of the present invention.
  • the agent is required to reduce the proteinaceous barrier formed over the surface to be treated, such as the pellicle over teeth.
  • suitable agents include bleach, detergent, chaotropic agents such as urea, high phosphate concentrations, cocktails of proteases (e.g. endopeptidases, proteinases and exopeptidases) and any other protein solubilizing, disrupting or hydrolysing agent.
  • bleaches include sodium hypochlorite (NaOCl), and cabamide peroxide bleaches.
  • the bleach is an alkaline bleach.
  • the alkaline bleach is NaOCl.
  • the protein disrupting agent acts to solubilize and partially or wholly remove proteins from the dental surface, particularly proteins of the pellicle.
  • the present invention relates to mineralizing a dental surface comprising by providing a protein disrupting agent and a source of ACP or ACFP.
  • the dental surface is enamel.
  • the present invention relates to treating fluorosis by contacting a fluorotic lesion in tooth enamel with a protein disrupting agent and stabilized ACP and/or ACFP.
  • the present invention relates to treating dental caries by contacting a caries lesion in tooth enamel with a protein disrupting agent and stabilized ACP and/or ACFP.
  • the present invention relates to treating dental erosion by contacting a lesion in tooth enamel caused by erosion with a protein disrupting agent and stabilized ACP and/or ACFP.
  • the present invention relates to reducing white spot lesions on the tooth enamel by contacting a white spot lesion with a protein disrupting agent and stabilized ACP and/or ACFP.
  • the present invention relates to remineralizing a lesion in tooth enamel by contacting the lesion with a protein disrupting agent and stabilized ACP and/or ACFP.
  • the ACP and/or ACFP is stabilized by a phosphopeptide.
  • the phosphopeptide is a casein phosphopeptides.
  • the ACP or ACFP is in the form of a casein phosphopeptide stabilized ACP or ACFP complex.
  • the protein disrupting agent is NaOCl.
  • a concentration of about 1 to 20% NaOCl may be used.
  • the concentration of NaOCl is 1 to 10%.
  • about 5% NaOCl is used.
  • the protein disrupting agent may be contacted with the dental surface for a period of about 1 to 60 minutes, or for about 1 to 30 minutes. In one embodiment, the protein disrupting agent is contacted with the dental surface for about 20 minutes.
  • the stabilized ACP and/or ACFP is contacted with the dental surface for a period of about 1 minute to 2 hours, or 5 minutes to 60 minutes or about 10 minutes.
  • the stabilized ACP and/or ACFP may be repeatedly applied to the dental surface over a period of 1 day to several months.
  • the stabilized ACP and/or ACFP is contacted with the dental surface after the dental surface has been contacted with the protein disrupting agent.
  • the protein disrupting agent is contacted with the dental surface 1 to 60 minutes, or 1 to 30 minutes, or 1 to 5 minutes prior to contacting the dental surface with the stabilized ACP and/or ACFP.
  • the present invention relates to mineralizing a tooth surface comprising applying an ACP and/or ACFP complex to a tooth surface that has been pre-treated with a protein disrupting agent.
  • a tooth surface is tooth enamel.
  • the tooth surface is tooth enamel containing a lesion selected from the group consisting of one or more of a white spot lesion; a fluorotic lesion; a caries lesion; or a lesion caused by tooth erosion.
  • the protein disrupting agent is a bleach.
  • the dental surface is in need of such treatment.
  • the invention also includes a method of treating a subject suffering fluorosis, dental caries, dentinal hypersensitivity or dental calculus.
  • pre-conditioning tooth enamel with a protein disrupting agent results in partial or complete enamel de-proteination, enhancing the diffusion of calcium and phosphate into subsurface enamel.
  • the method of the present invention includes stabilised ACFP.
  • Phosphopeptide in the context of the description of this invention means an amino acid sequence in which at least one amino acid is phosphorylated.
  • the phosphopeptide includes one or more of the amino acid sequence -A-B-C-, where A is a phosphoamino residue, B is any amino acyl residue including a phosphoamino residue and C is selected from a glutamyl, aspartyl or phosphoamino residue. Any of the phosphoamino residues may independently be a phosphoseryl residue.
  • B is desirably a residue the side-chain of which is neither relatively large nor hydrophobic. It may be Gly, Ala, Val, Met, Leu, Ile, Ser, Thr, Cys, Asp, Glu, Asn, Gln or Lys.
  • the phosphopeptide includes the sequence A-B-C-D-E, where A, B, C, D and E are independently phosphoserine, phosphothreonine, phosphotyrosine, phosphohistidine, glutamic acid or aspartic acid, and at least two, preferably three, of the A, B, C, D and E are a phosphoamino acid.
  • the phosphoamino acid residues are phosphoserine, most preferably three contiguous phosphoserine residues. It is also preferred that D and E are independently glutamic or aspartic acid.
  • the ACP or ACFP is stabilized by a casein phosphopeptide (CPP), which is in the form of intact casein or fragment of the casein, and the complex formed preferably has the formula [CPP(ACP) 8 ] n or [(CPP)(ACFP) 8 ] n where n is equal to or greater than 1, for example 6.
  • the complex formed may be a colloidal complex, where the core particles aggregate to form large (eg 100 nm) colloidal particles suspended in water.
  • the PP can be a casein protein or a polyphosphopeptide.
  • the PP may be from any source; it may be present in the context of a larger polypeptide, including a full length casein polypeptide, or it may be isolated by tryptic or other enzymatic or chemical digestion of casein, or other phosphoamino acid rich proteins such as phosphitin, or by chemical or recombinant synthesis, provided that it comprises the sequence -A-B-C- or A-B-C-D-E as described above.
  • the sequence flanking this core sequence may be any sequence. However, those flanking sequences in ⁇ s1 (59-79) [1]; ⁇ (1-25) [2], ⁇ s2 (46-70) [3] and ⁇ s2 (1-21) [4] are preferred.
  • the flanking sequences may optionally be modified by deletion, addition or conservative substitution of one or more residues.
  • the amino acid composition and sequence of the flanking region are not critical.
  • flanking sequences may also include non-naturally occurring amino acid residues.
  • Commonly encountered amino acids which are not encoded by the genetic code, include:
  • the PP is one or more phosphopeptides selected from the group consisting of ⁇ s1 (59-79) [1], ⁇ (1-25) [2], ⁇ s2 (46-70) [3] and ⁇ s2 (1-21) [4].
  • the stabilised ACFP or ACP complex is incorporated into oral compositions such as toothpaste, mouth washes or formulations for the mouth to aid in the prevention and/or treatment of dental caries, tooth decay, dental erosion or fluorosis.
  • the ACFP or ACP complex may comprise 0.01-50% by weight of the composition, preferably 1.0-50%.
  • the amount of the CPP-ACP and/or CPP-ACFP administered is 0.01 - 50% by weight, preferably 1.0% - 50% by weight of the composition.
  • the oral composition of the present invention contains about 2% CPP-ACP, CPP-ACFP or a mixture of both.
  • the oral composition of this invention which contains the above-mentioned agents may be prepared and used in various forms applicable to the mouth such as dentifrice including toothpastes, toothpowders and liquid dentifrices, mouthwashes, troches, chewing gums, dental pastes, gingival massage creams, gargle tablets, dairy products and other foodstuffs.
  • the oral composition according to this invention may further include additional well known ingredients depending on the type and form of a particular oral composition.
  • the oral composition may be substantially liquid in character, such as a mouthwash or rinse.
  • the vehicle is typically a water-alcohol mixture desirably including a humectant as described below.
  • the weight ratio of water to alcohol is in the range of from about 1:1 to about 20:1.
  • the total amount of water-alcohol mixture in this type of preparation is typically in the range of from about 70 to about 99.9% by weight of the preparation.
  • the alcohol is typically ethanol or isopropanol. Ethanol is preferred.
  • the pH of such liquid and other preparations of the invention is generally in the range of from about 5 to about 9 and typically from about 5.0 to 7.0.
  • the pH can be controlled with acid (e.g. phosphoric acid, citric acid or benzoic acid) or base (e.g. sodium hydroxide) or buffered (as with sodium citrate, benzoate, carbonate, or bicarbonate, disodium hydrogen phosphate, sodium dihydrogen phosphate, etc).
  • acid e.g. phosphoric acid, citric acid or benzoic acid
  • base e.g. sodium hydroxide
  • buffered as with sodium citrate, benzoate, carbonate, or bicarbonate, disodium hydrogen phosphate, sodium dihydrogen phosphate, etc.
  • the stabilised ACP or ACFP composition may be substantially solid or pasty in character, such as toothpowder, a dental tablet or a toothpaste (dental cream) or gel dentifrice.
  • the vehicle of such solid or pasty oral preparations generally contains dentally acceptable polishing material.
  • polishing materials are water-insoluble sodium metaphosphate, potassium metaphosphate, tricalcium phosphate, dihydrated calcium phosphate, anhydrous dicalcium phosphate, calcium pyrophosphate, magnesium orthophosphate, trimagnesium phosphate, calcium carbonate, hydrated alumina, calcined alumina, aluminium silicate, zirconium silicate, silica, bentonite, and mixtures thereof.
  • polishing material include the particulate thermosetting resins such as melamine-, phenolic, and urea-formaldehydes, and cross-linked polyepoxides and polyesters.
  • Preferred polishing materials include crystalline silica having particle sizes of up to about 5 microns, a mean particle size of up to about 1.1 microns, and a surface area of up to about 50,000 cm 2 /g., silica gel or colloidal silica, and complex amorphous alkali metal aluminosilicate.
  • alkali metal aluminosilicate complexes are particularly useful since they have refractive indices close to the refractive indices of gelling agent-liquid (including water and/or humectant) systems commonly used in dentifrices.
  • insoluble sodium metaphosphate may be formed in any suitable manner, for example as illustrated by Thorpe's Dictionary of Applied Chemistry, Volume 9, 4th Edition, pp. 510-511 .
  • the forms of insoluble sodium metaphosphate known as Madrell's salt and Kurrol's salt are further examples of suitable materials.
  • These metaphosphate salts exhibit only a minute solubility in water, and therefore are commonly referred to as insoluble metaphosphates (IMP).
  • IMP insoluble metaphosphates
  • impurities usually a few percent such as up to 4% by weight.
  • the amount of soluble phosphate material which is believed to include a soluble sodium trimetaphosphate in the case of insoluble metaphosphate, may be reduced or eliminated by washing with water if desired.
  • the insoluble alkali metal metaphosphate is typically employed in powder form of a particle size such that no more than 1 % of the material is larger than 37 microns.
  • the polishing material is generally present in the solid or pasty compositions in weight concentrations of about 10% to about 99%. Preferably, it is present in amounts from about 10% to about 75% in toothpaste, and from about 70% to about 99% in toothpowder. In toothpastes, when the polishing material is silicious in nature, it is generally present in an amount of about 10-30% by weight. Other polishing materials are typically present in amount of about 30-75% by weight.
  • the liquid vehicle may comprise water and humectant typically in an amount ranging from about 10% to about 80% by weight of the preparation.
  • humectant typically in an amount ranging from about 10% to about 80% by weight of the preparation.
  • Glycerine, propylene glycol, sorbitol and polypropylene glycol exemplify suitable humectants/carriers.
  • liquid mixtures of water, glycerine and sorbitol are particularly advantageous. In clear gels where the refractive index is an important consideration, about 2.5 - 30% w/w of water, 0 to about 70% w/w of glycerine and about 20-80% w/w of sorbitol are preferably employed.
  • Toothpaste, creams and gels typically contain a natural or synthetic thickener or gelling agent in proportions of about 0.1 to about 10, preferably about 0.5 to about 5% w/w.
  • a suitable thickener is synthetic hectorite, a synthetic colloidal magnesium alkali metal silicate complex clay available for example as Laponite (e.g. CP, SP 2002, D) marketed by Laporte Industries Limited.
  • Laponite D is, approximately by weight 58.00% SiO 2 25.40% MgO, 3.05% Na 2 O, 0.98% Li 2 O, and some water and trace metals. Its true specific gravity is 2.53 and it has an apparent bulk density of 1.0 g/ml at 8% moisture.
  • thickeners include Irish moss, iota carrageenan, gum tragacanth, starch, polyvinylpyrrolidone, hydroxyethylpropylcellulose, hydroxybutyl methyl cellulose, hydroxypropyl methyl cellulose, hydroxyethyl cellulose (e.g. available as Natrosol), sodium carboxymethyl cellulose, and colloidal silica such as finely ground Syloid (e.g. 244).
  • Irish moss iota carrageenan
  • gum tragacanth starch
  • polyvinylpyrrolidone hydroxyethylpropylcellulose
  • hydroxybutyl methyl cellulose hydroxypropyl methyl cellulose
  • sodium carboxymethyl cellulose hydroxyethyl cellulose
  • colloidal silica such as finely ground Syloid (e.g. 244).
  • Solubilizing agents may also be included such as humectant polyols such propylene glycol, dipropylene glycol and hexylene glycol, cellosolves such as methyl cellosolve and ethyl cellosolve, vegetable oils and waxes containing at least about 12 carbons in a straight chain such as olive oil, castor oil and petrolatum and esters such as amyl acetate, ethyl acetate and benzyl benzoate.
  • humectant polyols such propylene glycol, dipropylene glycol and hexylene glycol
  • cellosolves such as methyl cellosolve and ethyl cellosolve
  • vegetable oils and waxes containing at least about 12 carbons in a straight chain such as olive oil, castor oil and petrolatum and esters such as amyl acetate, ethyl acetate and benzyl benzoate.
  • a jar of mouth rinse will have a label describing it, in substance, as a mouth rinse or mouthwash and having directions for its use; and a toothpaste, cream or gel will usually be in a collapsible tube, typically aluminium, lined lead or plastic, or other squeeze, pump or pressurized dispenser for metering out the contents, having a label describing it, in substance, as a toothpaste, gel or dental cream.
  • Organic surface-active agents may be used in the compositions of the present invention to achieve increased prophylactic action, assist in achieving thorough and complete dispersion of the active agent throughout the oral cavity, and render the instant compositions more cosmetically acceptable.
  • the organic surface-active material is preferably anionic, non-ionic or ampholytic in nature and preferably does not interact with the active agent. It is preferred to employ as the surface-active agent a detersive material which imparts to the composition detersive and foaming properties.
  • anionic surfactants are water-soluble salts of higher fatty acid monoglyceride monosulfates, such as the sodium salt of the monosulfated monoglyceride of hydrogenated coconut oil fatty acids, higher alkyl sulfates such as sodium lauryl sulfate, alkyl aryl sulfonates such as sodium dodecyl benzene sulfonate, higher alkylsulfo-acetates, higher fatty acid esters of 1,2-dihydroxy propane sulfonate, and the substantially saturated higher aliphatic acyl amides of lower aliphatic amino carboxylic acid compounds, such as those having 12 to 16 carbons in the fatty acid, alkyl or acyl radicals, and the like.
  • Examples of the last mentioned amides are N-lauroyl sarcosine, and the sodium, potassium, and ethanolamine salts of N-lauroyl, N-myristoyl, or N-palmitoyl sarcosine which should be substantially free from soap or similar higher fatty acid material.
  • the use of these sarconite compounds in the oral compositions of the present invention is particularly advantageous since these materials exhibit a prolonged marked effect in the inhibition of acid formation in the oral cavity due to carbohydrates breakdown in addition to exerting some reduction in the solubility of tooth enamel in acid solutions.
  • Examples of water-soluble non-ionic surfactants suitable for use are condensation products of ethylene oxide with various reactive hydrogencontaining compounds reactive therewith having long hydrophobic chains (e.g.
  • condensation products contain hydrophilic polyoxyethylene moieties, such as condensation products of poly (ethylene oxide) with fatty acids, fatty alcohols, fatty amides, polyhydric alcohols (e.g. sorbitan monostearate) and polypropyleneoxide (e.g. Pluronic materials).
  • the surface active agent is typically present in amount of about 0.1-5% by weight. It is noteworthy, that the surface active agent may assist in the dissolving of the active agent of the invention and thereby diminish the amount of solubilizing humectant needed.
  • Various other materials may be incorporated in the oral preparations of this invention such as whitening agents, preservatives, silicones, chlorophyll compounds and/or ammoniated material such as urea, diammonium phosphate, and mixtures thereof.
  • whitening agents such as whitening agents, preservatives, silicones, chlorophyll compounds and/or ammoniated material such as urea, diammonium phosphate, and mixtures thereof.
  • flavouring or sweetening material may also be employed.
  • suitable flavouring constituents are flavouring oils, e.g. oil of spearmint, peppermint, wintergreen, sassafras, clove, sage, eucalyptus, marjoram, cinnamon, lemon, and orange, and methyl salicylate.
  • suitable sweetening agents include sucrose, lactose, maltose, sorbitol, xylitol, sodium cyclamate, perillartine, AMP (aspartyl phenyl alanine, methyl ester), saccharine, and the like.
  • flavour and sweetening agents may each or together comprise from about 0.1% to 5% more of the preparation.
  • the invention also provides an ACP or ACFP composition as described above further including a protein disrupting agent.
  • the protein disrupting agent is a bleach.
  • the bleach is NaOCl.
  • compositions of this invention can also be incorporated in lozenges, or in chewing gum or other products, e.g. by stirring into a warm gum base or coating the outer surface of a gum base, illustrative of which are jelutong, rubber latex, vinylite resins, etc., desirably with conventional plasticizers or softeners, sugar or other sweeteners or such as glucose, sorbitol and the like.
  • compositions including pharmaceutical compositions comprising any of the ACFP and/or ACP complexes as described above together with a protein disrupting agent and a pharmaceutically-acceptable carrier.
  • Such compositions may be selected from the group consisting of dental, anticariogenic compositions and therapeutic compositions.
  • Dental compositions or therapeutic compositions may be in the form of a gel, liquid, solid, powder, cream or lozenge.
  • Therapeutic compositions may also be in the form of tablets or capsules.
  • the ACP and/or ACFP complexes are substantially the only remineralizing active components of such a composition.
  • a crème formulation may be employed containing: water; glycerol; CPP-ACP; D-sorbitol; silicon dioxide; sodium carboxymethylcellulose (CMC-Na); propylene glycol; titanium dioxide; xylitol; phosphoric acid; guar gum; zinc oxide; sodium saccharin; ethyl p-hydroxybenzoate; magnesium oxide; butyl p-hydroxybenzoate and propyl p-hydroxybenzoate.
  • the invention further includes a formulation described above provided together with instructions for its use to treat or prevent any one or more of dental caries or tooth decay, dental erosion and fluorosis.
  • the active components of the composition consist essentially of the protein disrupting agent and stabilised ACP and/or ACFP. It is believed, without being bound by any theory or mode of action, that the stabilised ACP and/or ACFP and the protein disrupting agent are central to the therapeutic or preventative effect of the above embodiments of the invention, and thus embodiments consisting essentially of those components (with carriers, excipients and the like as required) are included within the scope of the invention.
  • the invention also relates to a kit for the treatment or prevention of one or more of dental caries, fluorosis and dental erosion including (a) a protein disrupting agent and (b) a CPP-ACP or CPP-ACFP complex in a pharmaceutically acceptable carrier.
  • the kit further includes instructions for their use for the mineralization of a dental surface in a patent in need of such treatment.
  • the agent and the complex are present in suitable amounts for treatment of a patient.
  • a method of treating or preventing one or more of each of dental caries, tooth decay, dental erosion and fluorosis comprising the steps of administering a protein disrupting agent to the teeth of a subject followed by administering an ACP or ACFP complex or composition.
  • Topical administration of the complex is preferred.
  • the method preferably includes the administration of the complex in a formulation as described above.
  • a protein disrupting agent in the manufacture of a first composition and use of stabilized amorphous calcium phosphate (ACP) or amorphous calcium fluoride phosphate (ACFP) in a manufacture of a second composition, the first and second compositions being used for the treatment and/or prevention of one or more of dental caries, tooth decay, dental erosion and fluorosis, wherein the first composition is applied to a dental surface prior to the second composition.
  • ACP stabilized amorphous calcium phosphate
  • ACFP amorphous calcium fluoride phosphate
  • a first composition including a protein disrupting agent and a second composition including stabilized amorphous calcium phosphate (ACP) or amorphous calcium fluoride phosphate (ACFP) for the treatment and/or prevention of one or more of dental caries, tooth decay, dental erosion and fluorosis, wherein the first composition is applied to a dental surface prior to the second composition.
  • ACP stabilized amorphous calcium phosphate
  • ACFP amorphous calcium fluoride phosphate
  • a mineralizing composition is a composition comprising the following (in decreasing order of proportion):
  • Tooth MousseTM Such a composition is available from GC corporation under the name Tooth MousseTM. This is suitable for use after a protein disrupting agent, and is in the form of a paste or crème to facilitate its retention on teeth for a suitable period.
  • this mineralizing composition may contain a protein disrupting agent, such as sodium hypochlorite.
  • the teeth were cleaned with a rotating rubber cup and pumice and rinsed in double deionized water (DDW) (Fejerskov et al., 1988).
  • the anatomical crowns were sectioned from the roots using a water-cooled diamond blade. Each crown was sectioned to provide a pair of enamel blocks each containing a FLE.
  • a 4x4 mm 2 window was created over each lesion by placing a rectangular piece of Parafilm® (American National Can, Chicago, III., USA.) over the lesion and covering the surrounding enamel with nail varnish (RevlonTM, New York, USA). The parafilm was then carefully removed to reveal the enamel lesion window which was divided into halves as control and test windows. The control window was covered with nail varnish.
  • the two lesions of each specimen were randomly assigned to one of two remineralization groups; Group I - treatment with 5% w/v CPP-ACFP and Group II - treatment with 5% w/v CPP-ACFP immediately following pre-conditioning with 5.25 % NaOCl.
  • CPP-ACFP was obtained from Recaldent Pty Ltd (Melbourne, Australia) and contained 47.6% w/w CPP, 15.7% w/w Ca 2+ , 22.9% w/w PO 4 3- and 1.2% w/w F - .
  • the CPP-ACFP was dissolved in distilled and deionized water at 5% w/v and adjusted to pH 7.0 with HCl.
  • each specimen was placed in 2ml of 5 % w/v, CPP-ACFP in a 5ml plastic vial at 37°C.
  • the CPP-ACFP solution was changed daily for 10 days.
  • each specimen was placed in a 5.25 % NaOCl solution for 20mins, rinsed and then placed in 2ml of 5 % w/v CPP-ACFP in a 5ml plastic vial at 37°C.
  • the CPP-ACFP solution was changed daily for 10 days.
  • a Chroma Meter (Minolta ChromaMeter CR241, Minolta, Japan) was used to record surface reflectance.
  • Surface reflectance measurement was established in L*a*b* color space by the Commission de L'Eclairage in 1978, and measurements relate to human colour perception in three colour dimensions (Commision Internationale de L'Eclaige, 1978).
  • the L* values represent colour gradients from white to black
  • a* values represent colour gradients from green to red
  • b* values represent colour gradients from blue to yellow (Commision Internationale de L'Eclaige, 1978). Only L* value measurements were used in this study with whiter colours having a higher reading, and darker colours a lower reading.
  • V volume of mineral as a percentage
  • tA the relative thickness of aluminium obtained from the gray value scanned
  • tS section thickness (80 ⁇ m).
  • DZ values were calculated using trapezoidal integration (Reynolds, 1997).
  • DZf The difference between the area under the profile of the untreated fluorotic enamel in the control window with adjacent normal enamel was designated DZf, and the difference between the area under the CPP-ACFP-treated fluorotic enamel in the test window and adjacent normal enamel was designated DZr.
  • Percentage mineralization (%M) of the fluorotic lesion was therefore (1- DZr/(DZf) x 100 (Reynolds, 1997).
  • the L*values of the untreated fluorotic enamel lesions ranged from 79.1 to 87.8 with a mean value of 83.6 ⁇ 3.6 (Table 1).
  • Treatment with 5% CPP-ACFP significantly reduced the L* value to 74.6 ⁇ 4.1, which was not significantly different to normal enamel (Table 1).
  • Pre-conditioning with NaOCl followed by 5% CPP-ACFP treatment significantly reduced the L* value to 72.6 ⁇ 5.6, which was also not significantly different to normal enamel (Table 1).
  • the appearance of the surface enamel of both treatment groups had substantially improved with both exhibiting the appearance of normal, translucent enamel.
  • Pre-conditioning of the enamel with NaOCl before CPP-ACFP treatment increased mineral uptake from 73.6% to 92.8% of the missing mineral with a mean value of 80.1 ⁇ 7.8% (Table 2).
  • Energy dispersive X-ray analysis of the mineralized lesion of the transverse sections confirmed the mineral formed by the CPP-ACFP treatment was a fluoride-containing apatite.
  • the patient is treated using the steps of:

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